Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients.

Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Research Abstract Details 

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Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Abstract Text:

Joseph V Agostini,Ying Zhang,Sharon K Inouye,

OBJECTIVES: To develop a feasible, inexpensive, point-of-care computerized reminder to improve sedative-hypnotic prescribing in hospitalized older people. DESIGN: Pre-postintervention with a computer-based reminder. SETTING: Academic medical center. PARTICIPANTS: Hospitalized patients aged 65 and older. INTERVENTION: Computer-based reminder directing clinicians to prescribe a nonpharmacological sleep protocol, to minimize the potential for harm with diphenhydramine and diazepam use by choosing an alternative medication (trazodone or lorazepam), or both. MEASUREMENTS: Frequency of prescription of four sedative-hypnotic drugs (diphenhydramine, diazepam, lorazepam, and trazodone) during the 12 months before (n=12,356 patients) and after (n=12,153) the reminder was instituted. RESULTS: Prescribing of sedative-hypnotics decreased from 2,208 per 12,356 (18%) patients preintervention to 1,832 per 12,153 (15%) postintervention (odds ratio for the intervention=0.82, 95% confidence interval=0.76-0.87), an 18% risk reduction. Combined prescription rates for all four drugs fell consistently throughout the postintervention period. Diphenhydramine, diazepam, and lorazepam orders declined overall, with lorazepam prescriptions decreasing 39% during the intervention. Ninety-five percent of patients were successfully directed to a safer sedative-hypnotic drug or a nonpharmacological sleep protocol. CONCLUSION: Using real-time computer-based reminders could lead to improved sedative-hypnotic prescribing for older persons in acute care. This study highlights the potential to address patient safety concerns, and the quality of medication prescribing in particular, in vulnerable hospitalized patients.

Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Publishing Authors By Initials

JV Agostini,Y Zhang,SK Inouye,

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Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Journal Published:

PUBLICATION TYPE: Research Support, U.S. Gov't,

Journal: Journal of the American Geriatrics Society

VOLUME: 55

Page Numbers: 43-8

Journal Abbreviation:

ISSN: 0002-8614

DAY: 3

MONTH: Jan

YEAR: 2007

Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Information

Number of References:

LANGUAGE: eng

NlmUniqueID: 7503062

Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Keywords Mesh Terms:

KEYWORDS: Sleep Initiation and Maintenance Disorde

MESH TERMS: therapy

Chemical & Substance for Abstract: Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. Information

Substance Name: Hypnotics and Sedatives

Registry Number: 0

Grant and Affiliation Information for Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients.

AFFILIATION: Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, CT 06516, USA. joseph.agostini@yale.edu

Country: United States

AGENCY: United States NIA

GRANT: R21 AG025193

ACRONYM: AG

MEDLINETA: J Am Geriatr Soc

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